JOPIC
Journal of Pulmonology and Intensive Care

The JoPIC is an independent-unbiased, peer-reviewed, and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, surgical techniques, differential diagnoses, editorial opinions, letters to the editor, and educational papers in pulmonology, thoracic surgery, occupational diseases, allergology, and intensive care medicine.

eISSN: 2980-0803
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Review
Current diagnostic criteria, therapeutic approaches, and long-term outcomes in acute respiratory distress syndrome
Abstract
Acute Respiratory Distress Syndrome (ARDS) is a common condition in intensive care units, characterized by severe hypoxemic respiratory failure. It typically develops following triggering factors such as pneumonia or sepsis. Diagnosis is based on clinical and radiological findings in conjunction with oxygenation parameters, and the syndrome is classified as mild, moderate, or severe. Key management strategies include low tidal volume ventilation, appropriate positive end-expiratory pressure, prone positioning, and extracorporeal membrane oxygenation in selected cases. Corticosteroids and neuromuscular blocking agents should be used with caution in specific patient groups. Since survivors of ARDS are at risk for long-term physical, cognitive, and psychological impairments, rehabilitation and long-term follow-up are of paramount importance. This article provides an updated overview of the diagnosis, differential diagnosis, treatment strategies, and long-term management of ARDS.

Keywords : ARDS, alveolar damage, hypoxemia, intensive care

Download Article


1. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967;2(7511):319-323. doi:10.1016/s0140-6736 (67)90168-7
2. Ferguson ND, Fan E, Camporota L, et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012;38(10):1573-1582. doi:10.1007/s00134-012-2682-1
3. Hughes KT, Beasley MB. Pulmonary manifestations of acute lung injury: more than just diffuse alveolar damage. Arch Pathol Lab Med. 2017;141(7):916-922. doi:10.5858/arpa.2016-0342-RA
4. Wilson JG, Liu KD, Zhuo H, et al. Mesenchymal stem (stromal) cells for treatment of ARDS: a phase 1 clinical trial. Lancet Respir Med. 2015; 3(1):24-32. doi:10.1016/S2213-2600(14)70291-7
5. Kiiski R, Takala J, Kari A, Milic-Emili J. Effect of tidal volume on gas exchange and oxygen transport in the adult respiratory distress syndrome. Am Rev Respir Dis. 1992;146(5 Pt 1):1131-1135. doi:10.1164/ajrccm/146.5_Pt_1.1131
6. Roupie E, Dambrosio M, Servillo G, et al. Titration of tidal volume and induced hypercapnia in acute respiratory distress syndrome. Am J Respir Crit Care Med. 1995;152(1):121-128. doi:10.1164/ajrccm.152.1. 7599810
7. Griffiths MJD, McAuley DF, Perkins GD, et al. Guidelines on the management of acute respiratory distress syndrome. BMJ Open Respir Res. 2019;6(1):e000420. doi:10.1136/bmjresp-2019-000420
8. Grasselli G, Calfee CS, Camporota L, et al. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. 2023;49(7):727-759. doi:10.1007/s00134-023-07050-7
9. Schwarz MI, Albert RK. “Imitators” of the ARDS: implications for diagnosis and treatment. Chest. 2004;125(4):1530-1535. doi:10.1378/chest.125.4.1530
10. Dorward DA, Russell CD, Um IH, et al.<strong> </strong>Tissue-specific immunopathology in fatal COVID-19. Am J Respir Crit Care Med. 2021; 203(2):192-201. doi:10.1164/rccm.202008-3265OC
11. Swenson KE, Swenson ER.<strong> </strong>Pathophysiology of acute respiratory distress syndrome and COVID-19 lung injury. Crit Care Clin. 2021;37(4):749-776. doi:10.1016/j.ccc.2021.05.003
12. Ackermann M, Verleden SE, Kuehnel M, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in COVID-19. N Engl J Med. 2020;383(2):120-128. doi:10.1056/NEJMoa2015432
13. Silversides JA, Major E, Ferguson AJ, et al. Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis. Intensive Care Med. 2017;43(2):155-170. doi:10.1007/s00134-016-4573-3
14. Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363(12):1107-1116. doi:10.1056/NEJMoa1005372
15. Qadir N, Sahetya S, Munshi L, et al. An update on management of adult patients with acute respiratory distress syndrome: an official American thoracic society clinical practice guideline. Am J Respir Crit Care Med. 2024;209(1):24-36. doi:10.1164/rccm.202311-2011ST
16. Annane D, Pastores SM, Rochwerg B, et al. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Med. 2017;43(12):1751-1763. doi:10.1007/s00134-017-4919-5
17. Villar J, Ferrando C, Mart&iacute;nez D, et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med. 2020;8(3):267-276. doi:10.1016/S2213-2600(19)30417-5
18. Karam O, Gebistorf F, Wetterslev J, Afshari A. The effect of inhaled nitric oxide in acute respiratory distress syndrome in children and adults: a cochrane systematic review with trial sequential analysis. Anaesthesia. 2017;72(1):106-117. doi:10.1111/anae.13628
19. Martindale RG, McClave SA, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: society of critical care medicine and american society for parenteral and enteral nutrition: executive summary. Crit Care Med. 2009;37(5):175. doi:10.1097/CCM.0b013e3181a40116
20. Zampieri FG, P&oacute;voa P, Salluh JI, et al. Lower respiratory tract infection and short-term outcome in patients with acute respiratory distress syndrome. J Intensive Care Med. 2020;35(6):588-594. doi:10.1177/ 0885066618772498
21. Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788-800. doi:10. 1001/jama.2016.0291
22. Umoh NJ, Fan E, Mendez-Tellez PA, et al. Patient and intensive care unit organizational factors associated with low tidal volume ventilation in acute lung injury. Crit Care Med. 2008;36(5):1463-1468. doi:10.1097/CCM.0b013e31816fc3d0
23. Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000; 342(18):1301-1308. doi:10.1056/NEJM200005043421801
24. de Durante G, del Turco M, Rustichini L, et al. Lower tidal volume ventilatory strategy may generate intrinsic positive end-expiratory pressure in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2002;165(9):1271-1274. doi:10.1164/rccm.2105050
25. Santa Cruz R, Villarejo F, Irrazabal C, Ciapponi A. High versus low positive end-expiratory pressure (PEEP) levels for mechanically ventilated adult patients with acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev. 2021;3(3):CD009098. doi:10.1002/14651858.CD009098.pub3
26. Kregenow DA, Rubenfeld GD, Hudson LD, Swenson ER. Hypercapnic acidosis and mortality in acute lung injury. Crit Care Med. 2006;34(1):1-7. doi:10.1097/01.ccm.0000194533.75481.03
27. Hiser SL, Fatima A, Ali M, Needham DM. Post-intensive care syndrome (PICS): recent updates. J Intensive Care. 2023;11(1):23. doi:10.1186/s40560-023-00670-7
28. Ilias I, Mantziou V, Vamvakas E, et al. Post-traumatic stress disorder and burnout in healthcare professionals during the sars-cov-2 pandemic: a cross-sectional study. J Crit Care Med (Targu Mures). 2021; 7(1):14-20. doi:10.2478/jccm-2020-0042
Article available in :
Volume 3, Issue 2, 2025
Page : 32-37
https://doi.org/10.51271/JOPIC-0053
Article Information
Received : 26 Nis 2025
Accepted : 15 May 2025
Published : 29 May 2025
Corresponding Author :

Maşide Arı: Department of Pulmonology, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkiye

[email protected]
Citation : Arı M. Current diagnostic criteria, therapeutic approaches, and long-term outcomes in acute respiratory distress syndrome. J Pulmonol Intens Care. 2025;3(2):32-37.

Read: 281
Download : 1051
Cited: 0
_Footer